Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of hyperthyroidism occurring in a 68 year old man receiving lithium carbonate (1 g/day) for 5 years is reported. The clinical history of the patient, treated for bipolar affective disorder, was remarkable for transient hypothyroidism followed several months later by tremor, increased free thyroxine and triiodothyronine, and decreased TSH levels which led to lithium withdrawal. Two months later, clinical and biological signs were unchanged, Tc99m-scan displayed a homogeneous and increased isotope uptake. In this setting, high levels of autoantibodies against TSH-receptor, and grade I exophthalmos and slightly ocular muscle enlargement at CT-scan favored the diagnosis of Graves' disease (perhaps facilitated by lithium therapy). Carbimazole treatment was effective in controlling hyperthyroidism. Review of the literature disclosed 44 cases of hyperthyroidism occurring in lithium-treated patients. Most of these cases concerned specific thyroid diseases, particularly with an autoimmune mechanism. There is also evidence for an actual role of lithium in increasing intrathyroid iodide pool and for an impact of lithium on the immune system. Thus, the hypothesis that lithium may trigger the development of an autoimmune thyroid disease in predisposed patients deserves further investigation.
 ...
PMID:[Lithium therapy and hyperthyroidism: disease caused or facilitated by lithium? Review of the literature apropos of a case of hyperthyroidism preceded by transient hypothyroidism]. 808 84

What is the best treatment for adults with Graves' disease in 2016? To answer this question, we reviewed the literature using the standard Prescrire methodology. When the symptoms of hyperthyroidism are poorly tolerated, a beta-blocker relieves tachy- cardia, anxiety and tremor. Three treatments have been shown to be effec- tive in controlling hyperthyroidism: antithyroid drugs, radioiodine, and thyroidectomy. Carbimazole and its metabolite thiamazole are the antithyroid drugs with the best harm-benefit balance, except during the first trimester of preg- nancy. About 50% of patients are cured after 12 to 18 months of treatment. Antithyroid drugs carry a risk of rare but serious adverse effects, including agranulocytosis. Hepa- titis is more frequent with propylthiouracil. Radioiodine is administered as a single oral dose, in order to destroy the thyroid gland. Perma- nent cure is achieved in about 80% of cases, usu- ally after 1 or 2 months. Permanent hypothyroid- ism is frequent, occurring at various intervals after treatment. Radioiodine may exacerbate pre-existing oph- thalmopathy or provoke its onset, especially among smokers. Corticosteroid therapy reduces this risk. Protective measures are used for a few days or weeks in order to avoid radiation exposure among close contacts. Radioiodine is contraindi- cated during pregnancy. Surgical thyroidectomy may be total with little risk of recurrence, or subtotal with about an 8% risk of recurrence. The complications of surgery mainly consist of. hypoparathyroidism and permanent paralysis of the recurrent laryngeal nerve, which occur after 1% to 5% of procedures. In practice, the choice of treatment depends on the patient's preferences and situation, including a woman's desire to conceive, size of the goitre, the degree of hyperthyroidism, and the presence of ophthalmopathy.
 ...
PMID:Graves' disease in adults Antithyroid drugs, radioactive iodine, or sometimes thyroidectomy. 3073 Jun 22